Commentary on “Reconstruction of an extensive tibial soft tissue defect with multiple local muscle flaps for limb salvage when free tissue transfer was not an option”, by Thornton and Pu

Commentary on “Reconstruction of an extensive tibial soft tissue defect with multiple local...
Vesely, J.
2004-10-01 00:00:00
Eur J Plast Surg (2004) 27:223 DOI 10.1007/s00238-004-0659-1 IN VI TED C OMMENTARY J. Vesely Commentary on “Reconstruction of an extensive tibial soft tissue defect with multiple local muscle flaps for limb salvage when free tissue transfer was not an option”, by Thornton and Pu Published online: 9 September 2004 Springer-Verlag 2004 The lower extremities can be considered as a delicate than the rotation of multiple muscle flaps. Such patients aging indicator, especially in elderly people who develop must be cared for in medical centers, where problems vascular changes that are usually of venous or arterial which other hospitals are not able to deal with are not a origin. Advanced chronic venous insufficiency, systemic contraindication to microsurgical procedures. Therefore, sclerosis or chronic ulcers (e.g., in diabetic feet) help to we suggest that every such patient should be examined by provide conditions where even small surgery can cause an experienced plastic surgeon in a microsurgical center. considerable edema, wound dehiscence and lots of com- Reading case one, I am not sure when the hardware plications which are normally caused by excessive scar- was removed. I believe it was done before washouts, and ring. Although medical science is devoting more effort some kind of external fixation was put on to stabilize the toward understanding and offering therapy to control scar tibia. I remember a patient who has suffered from manic formation, we are able to influence scarring slightly but depressive symptoms and who had a defect of the lower not totally. extremity. This patient underwent microsurgical free-flap In my opinion, the use of multiple local muscle flaps reconstruction of the sole, and we followed him up for for limb salvage can initiate the aforementioned tissue four years without any problems with regards to flap scar formation, and this may be the cause of later tissue healing. ischemia. Eventually, chronic ischemic conditions may The true reason for flap necrosis in case two is doubt- result in poor healing followed by wound dehiscence. ful. In my opinion the necrosis of the free flap was due I do not totally agree with the philosophy of the paper. to an arterial thrombosis. A venous thrombosis is less Both cases are typical microsurgical ones. Cutaneous free probable. This could be caused by the patient being mo- flaps to cover the tibia with split skin grafts placed on bilized too early. surrounding tissues are surgical solutions which are easier J. Vesely ( ) Clinic for Plastic and Aesthetic Surgery, St. Anna’s University Hospital, Masaryk University, Berkova 34, 612 00 Brno, Czech Republic e-mail: jvesely@med.muni.cz
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Commentary on “Reconstruction of an extensive tibial soft tissue defect with multiple local muscle flaps for limb salvage when free tissue transfer was not an option”, by Thornton and Pu

Abstract

Eur J Plast Surg (2004) 27:223 DOI 10.1007/s00238-004-0659-1 IN VI TED C OMMENTARY J. Vesely Commentary on “Reconstruction of an extensive tibial soft tissue defect with multiple local muscle flaps for limb salvage when free tissue transfer was not an option”, by Thornton and Pu Published online: 9 September 2004 Springer-Verlag 2004 The lower extremities can be considered as a delicate than the rotation of multiple muscle flaps. Such patients aging indicator, especially in elderly people who develop must be cared for in medical centers, where problems vascular changes that are usually of venous or arterial which other hospitals are not able to deal with are not a origin. Advanced chronic venous insufficiency, systemic contraindication to microsurgical procedures. Therefore, sclerosis or chronic ulcers (e.g., in diabetic feet) help to we suggest that every such patient should be examined by provide conditions where even small surgery can cause an experienced plastic surgeon in a microsurgical center. considerable edema, wound dehiscence and lots of com- Reading case one, I am not sure when the hardware plications which are normally caused by excessive scar- was removed. I believe it was done before washouts, and ring. Although medical science is devoting more effort some kind of external fixation was put on to stabilize the toward understanding and offering therapy to control scar tibia. I remember a patient who has suffered from manic formation, we are able to influence scarring slightly but depressive symptoms and who had a defect of the lower not totally. extremity. This patient underwent microsurgical free-flap In my opinion, the use of multiple local muscle flaps reconstruction of the sole, and we followed him up for for limb salvage can initiate the aforementioned tissue four years without any problems with regards to flap scar formation, and this may be the cause of later tissue healing. ischemia. Eventually, chronic ischemic conditions may The true reason for flap necrosis in case two is doubt- result in poor healing followed by wound dehiscence. ful. In my opinion the necrosis of the free flap was due I do not totally agree with the philosophy of the paper. to an arterial thrombosis. A venous thrombosis is less Both cases are typical microsurgical ones. Cutaneous free probable. This could be caused by the patient being mo- flaps to cover the tibia with split skin grafts placed on bilized too early. surrounding tissues are surgical solutions which are easier J. Vesely ( ) Clinic for Plastic and Aesthetic Surgery, St. Anna’s University Hospital, Masaryk University, Berkova 34, 612 00 Brno, Czech Republic e-mail: jvesely@med.muni.cz